Committee Nomination

Nominator
Address*
Street Address Address Line 2 City ZIP / Postal Code
Mobile*
Home Phone*
Work Number
Email*
I wish to nominate the following member for election to the Hurricane Go Kart Club committee.
Nominee*
I confirm my willingness to stand for election to the Hurricane Go Kart Club committee and declare that I am not:
a) an undischarged bankrupt or a person whose affairs are under insolvency laws;
b) a person convicted of an offence involving fraud or dishonesty punishable on conviction by 3 months or more imprisonment; or
c) a person convicted of an offence in connection with the promotion, formation or management of a body corporate, including the duties provisions under the Act.
Nominee*
Address*
Street Address Address Line 2 City ZIP / Postal Code
Mobile*
Home Phone*
Work Number
Email*
To be valid, this form must be received no later than 7 days before the Annual General Election.
Date
DD slash MM slash YYYY
Name
This field is for validation purposes and should be left unchanged.